PURPOSE: Few studies have examined chronic cough and the applicability of the 1998 ACCP consensus panel report among Asians. This study was undertaken to determine: (1) the degree of compliance of pulmonary specialists to the ACCP recommendations and (2) the prevalence of causes and the outcome of treatment.
METHODS: We followed the evaluation and management of unselected immunocompetent adults, age ≥18 years, consulting at the pulmonary clinics of a university teaching hospital (January 2003- December 2004) for cough≥3 weeks. The attending physicians were not aware of the study. We developed and pre-tested a 19-item yes-or-no compliance checklist. Compliance assessment is based on the concurring judgement of at least 2 of 3 independent board-certified pulmonologists. Epi Info 6 and Stata 7 were used for statistical analyses, at α, p= 0.05. Assuming compliance is achieved in only 10% of patients and accounting for a sampling design clustering effect of 1.5, the required number of evaluable subjects is 209.
RESULTS: 284 patients were seen (61.3% females; age= 50.18±18.69 years; cough duration= 22.2±55.64 weeks). 50 were lost to follow up. The overall compliance rate was 84% (±11.71). Major deviations included the use of empiric drug therapy in 70% and non-specific cough therapy at the outset in 40% of patients. These deviations were highest among patients with GERD, PNDS and asthma. The causes of cough were determined in 99.5%. Asthma (33.3%), PNDS (30.4%) and PTB (20.3%) were top etiologies. GERD was found in only 3.8%. Cough resolved completely in 63% and significantly improved in 32.5%. Treatment outcome was not influenced by the overall compliance and the use of empiric drug treatment.
CONCLUSION: The ACCP recommendations are generally applicable to an Asian setting. Cough etiology is determined and successful management is achieved in the majority of patients.
CLINICAL IMPLICATIONS: However, modifications are needed to address locally unique problems. In the Philippines, PTB should be considered early on. Empiric drug therapy when there is a high clinical suspicion for asthma, PNDS or GERD is likewise feasible.
DISCLOSURE: Aileen David-Wang, None.